Category Archives: Uncategorised

Case 147 summary: VITT

Many thanks for following our case this week of a young patient with VITT – a syndrome which emerged in Spring 2021 and offered significant challenges to treat Following extensive roll-out of vaccines to protect against SARS-CoV-2, concerns arose around … Continue reading

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Case 147 – Update 3

Our 34 year-old female patient with VITT has responded well to plasma exchange, IVIg and anticoagulation and is now in neuro-rehabilitation with a normal FBC and is due to be discharged. The rehab medicine team wish to have your advice … Continue reading

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Case 147 – Update 2

We have a 34 year-old female patient presenting with headache, thrombocytopenia (plt 25) and intracranial haemorrhage requiring a decompressive craniectomy. She had the ChAdOx1 nCoV-19 (AstraZeneca) vaccine 13 days ago. D-dimers are significantly elevated at 35,283 and subsequent CT venogram … Continue reading

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Case 147 – Update 1

We have a 34 year-old female patient who has presented with headache, thrombocytopenia (plt 25) and intracranial haemorrhage requiring a decompressive craniectomy which was supported with 2 pools of platelets pre-operatively and a further pool intra-operatively. She is now on … Continue reading

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Case 147 – the beginning

It is 4am and you are peacefully dreaming about the educational opportunities at #BBTS2021 when you are awoken by the neurosurgical SpR on-call. They would like advice around product support for a patient they wish to take to theatre for … Continue reading

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Case 145 – summary

Antiphospholipid syndrome (APS) is an acquired autoimmune disease characterised by laboratory criteria (persistent antiphospholipid antibodies) and clinical criteria (venous/arterial/micro-thromboses and/or pregnancy morbidity). Catastrophic antiphospholipid syndrome (CAPS) is a rare manifestation of APS, which is characterised by rapid onset of multi-organ … Continue reading

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Case 146 – summary

Marginal zone lymphoma is a type of low grade B-cell non-Hodgkin lymphoma. It can be sub-classified as nodal, splenic, and extra-nodal (EMZL) of mucosa-associated lymphoid tissue (MALT). They make up 5-15% of all non-Hodgkin lymphomas in the Western world. EMZL … Continue reading

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Case 146 – update 4

Our patient undergoes involved-field radiotherapy to her stomach and perigastric lymph nodes with good clinical and radiological results – however, her surveillance biopsies remain positive for residual lymphoma. As she is asymptomatic, she resumes a watchful waiting approach. After 9 … Continue reading

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Case 146 – update 5

Repeat CT scanning at this point shows recurrence of this lady’s perigastric lymphadenopathy, as well as bilateral neck and left axillary nodes. She is commenced on systemic treatment with rituximab and chlorambucil, which she tolerates well without major side effects. … Continue reading

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Case 146 – update 3

This lady has had a partial response after eradication therapy but is asymptomatic, so continues active monitoring with 3-monthly OGDs. After about 12 months, she becomes symptomatic again with abdominal discomfort. CT scanning shows gastric wall thickening and perigastric lymphadenopathy … Continue reading

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Case 146 – update 2

This lady has been diagnosed with stage IE extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma), Helicobater pylori positive. She has completed 4 weeks of triple eradication therapy with lansoprazole, amoxicillin and clarithromycin, and her H. pylori test … Continue reading

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Case 146 – update 1

You have arranged for this lady to have a CT chest/abdomen/pelvis which, apart from thickening of the stomach lining, is unremarkable. Her final biopsy results are reported as follows: “There is a diffuse atypical lymphoid infiltrate of medium sized cells … Continue reading

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Case 146 – the beginning

You are about to see a new patient in the Haematology clinic. She is a 58-year old lady with a background of hypertension. Ramipril is her only medication. She is otherwise fit and well. She has been referred to you … Continue reading

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Case 145 – continued

The critical care team inform you that while he was on LMWH prophylaxis whilst an inpatient for his acute appendicitis, he has not had any further heparin exposure in the last three weeks. Further investigations are arranged with results as … Continue reading

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Case 145 – the beginning

You are on-call for haematology and receive a call from the critical care team regarding a 36-year-old male with a complex medical history. With the exception of an episode of uncomplicated acute appendicitis 3 weeks ago which required a laparoscopic … Continue reading

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Case 144 – Summary

The case this week focused on the use of Viscoelastic Haemostatic assays (VHA). The patient had a ruptured AAA. Initial TEG testing was normal but she continued to bleed. Repeat TEG showed she had developed shortened R time and increased … Continue reading

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Case 144 -update 4

The clinical team looking after the lady are not happy to give tranexamic acid as they feel it will be a thrombotic risk. They do accept advice to give 4FFP and a pool of platelets given the long R time … Continue reading

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Case 144 – update 4

The clinical team looking after the lady are not happy to give tranexamic acid as they feel will be a thrombotic risk. They do accept advice to give 4FFP and a pool of platelets given the long R time and … Continue reading

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Case 144 – update 3

The lady has been taken to theatre but the team have noted she is becoming more unstable despite ongoing replacement with the Major Haemorrhage packs She had 4 RBC 4 FFP and you advised 2 cryo following initial lab tests. … Continue reading

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Case 144 – update 1

You establish the patients isn’t on any anticoagulants or antiplatelet agents. She has no cardiac history and the team don’t know about her blood group. She had an ABG that shows a Hb of 64. You advise the team that … Continue reading

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